Staphylococcus aureus infection as a complication of isotretinoin therapy

Leyden, J. J.

doi:10.1001/archderm.123.5.606

Cited by 19 publications

(21 citation statements)

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“…Retinoids improve dermatoses in the pathogenesis of which bacterial agents are implicated such as acne and gram-negative folliculitis [13, 14, 15, 16, 17]. In patients treated with oral 13- cis -RA profound alterations of the skin flora are observed, such as reduced recovery of P. acnes and gram-negative bacteria, increased nasal colonization by S. aureus and a high incidence of staphylococcal cutaneous infection [13].…”

Section: Discussionmentioning

confidence: 99%

“…In patients treated with oral 13- cis -RA profound alterations of the skin flora are observed, such as reduced recovery of P. acnes and gram-negative bacteria, increased nasal colonization by S. aureus and a high incidence of staphylococcal cutaneous infection [13]. However, in vitro experiments with 13- cis -RA [13, 14, 15, 16, 17]and acitretin [14]failed to reveal any direct antibacterial activities against either gram-positive or gram-negative bacteria. Since RA does not inhibit bacterial growth by itself [13, 14], this study], changes in skin bacteria likely result from indirect mechanisms, such as reduction of the skin lipid or drying effects.…”

Section: Discussionmentioning

confidence: 99%

“…However, in vitro experiments with 13- cis -RA [13, 14, 15, 16, 17]and acitretin [14]failed to reveal any direct antibacterial activities against either gram-positive or gram-negative bacteria. Since RA does not inhibit bacterial growth by itself [13, 14], this study], changes in skin bacteria likely result from indirect mechanisms, such as reduction of the skin lipid or drying effects.…”

Section: Discussionmentioning

confidence: 99%

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The Antibacterial Activity of Topical Retinoids: The Case of Retinaldehyde

Péchère

Germanier²,

Siegenthaler³

et al. 2002

Dermatology

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Background: Retinoids such as retinoic acid (RA), retinol (ROL) and retinaldehyde (RAL) are currently used in many formulations and indications ranging form acne to skin aging. Most if not all their pharmacological activities occur through binding to nuclear receptors with subsequent modulation of the activities of several genes. Little attention has been given to the many other potential actions on the surface of the skin. Aim: To analyse the potential anti-infective activities of topical ROL, RAL and RA. Methods: Microbial minimal inhibitory concentrations (MIC) of ROL, RAL and RA were determined by a microdilution method on reference strains including Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus flavus, Propionibacterium acnes, Micrococcus luteus, Enterococcus faecium,Staphylococcus hominis, Escherichia coli, Pseudomonas aeruginosa, Candida albicans and 133 clinical strains including methicillin-resistant S. aureus, methicillin-sensitive S. aureus, coagulase-negative Staphylococcus, Streptococcus group B, Enterococcus faecalis, vancomycin-resitant E. faecalis, vancomycin-resistant E. faecium and Pseudomonas/Klebsiella. In two clinical trials in healthy human volunteers, skin bacterial densities were evaluated in samples obtained with the cylinder scrub method: (1) 2 and 5 h after a single application of 0.05% RAL or vehicle on the forearm and (2) in a single-blind randomized study where 0.05% RAL or vehicle were applied daily for 2 weeks on the forehead of 22 volunteers. Paired results from treated (or vehicle) and untreated areas were analysed. Results: Of the three retinoids tested, only RAL showed a significant in vitro antibacterial activity; this activity was found against reference strains of gram-positive bacteria like S. aeureus, Micrococcus spp. or P. acnes. No activity was found against gram-negative bacteria. These results on reference strains were confirmed on 133 clinical isolates. MIC₅₀ and MIC₉₀ values for RAL were 8 and 16 mg/l, respectively, for methicillin-sensitive S. aureus and 4 and 8 mg/l for methicillin-resistant S. aureus. The two in vivo studies showed that areas treated with RAL had a significant decrease in the bacterial counts. In the forehead study, the median decrease was 10² log/cm² for P. acnes and 10^1.8 log/cm² for staphylococci. No resistant bacteria were found after 2 weeks of topical use. Preliminary results suggest that the antibacterial effect of RAL is due, in part, to the aldehyde group in the lateral chain, since non-retinoid pseudo-analogues of the chain, like citral and hexenal, showed a similar antibacterial activity. Conclusion: We have shown that RAL differs from parent natural retinoids such as ROL and RA in demonstrating significant antibacterial activities upon topical use. This activity is likely due to the aldehyde group in the isoprenoic lateral chain, which illustrates the potential bifunctional properties of some retinoids.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Antibacterial Activity of Topical Retinoids: The Case of Retinaldehyde

Péchère

Germanier²,

Siegenthaler³

et al. 2002

Dermatology

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“…12 There have not been any data on whether the carriage of methicillin-resistant Staphylococcus aureus has increased. Less commonly, patients may have stimulation of granulation tissue, leading to pyogenic granuloma eruptions in acne lesions, areas of trauma, and in nail folds ( Figure 2).…”

Section: Mucocutaneous Side Effectsmentioning

confidence: 99%

Preventing and Managing the Side Effects of Isotretinoin

Brelsford¹,

Beute²

2008

Seminars in Cutaneous Medicine and Surgery

122

111

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“…However, increased S aureus colonization of the nasal mucosa and skin is well established, 4 and cases of S aureus infection associated with isotretinoin therapy are reported. 5,6 Isotretinoin should be recognized as a risk factor for developing infections such as septic bursitis after percutaneous injection. Physicians performing these injections should be aware of this uncommon complication.…”

mentioning

confidence: 99%